Some thoughts about the Autistic internal system and therapy

The word “autism” was coined in 1912 by Paul Bleuler, a Swiss psychiatrist. “Auto” as a prefix comes from the Greek word “autos” which means “self, one's own, by oneself, of oneself.” “Ismos” as a suffix refers to state (ism). The “ic” in Autistic means “of / pertaining to”. So literally it means something like “pertaining to a state of selfhood”.

The original notion was of "morbid self-absorption." A kinder definition I have heard over the years is that to be autistic is to be a person who does everything themselves in their own way. This links with words such as Authenticity and Autonomy. I also believe there is a sense in which self-sufficiency for autistic people has become the default not because it is our preferred way of being but rather because it has been the most adaptive survival strategy.

Self sufficiency

A lifelong history of misattunement and a tendency towards self sufficiency can make therapies such as IFS very attractive to autistic people – the idea of not needing to “rely” on a therapist and to “do it all myself”. Often, however, the concept of Self can be hard to fathom for autistic people. Perhaps we experience it differently to non autistic people or perhaps due to trauma we find it difficult to access it at all. It can also seem “airy fairy” or too good to be true and we are so used to managing everything ourselves so we simply allocate one of our “parts” to play that role. Unfortunately this can perpetuate our tendency to mask and / or increase the risk of us being shamed by the “Self police” who can weaponise the concept of Self to the extent where we feel discouraged and as if we are doing it wrong (again).

It can be so hard to trust and to let down the barrier of our own self system when that has been all we have known for so long, all we have had to rely on to “hold it together”. I do believe that autistic people are not “loners” by nature and that we do need the right type of connections. And I also tend to believe that for deep healing we need a relational process.

Autistic people tend to carry a severe lack of validation for who we actually are – we have “spiky” profiles which means our capacities in one area may be wildly out of sync with our needs in another. This can also vary from day to day and depending on the environment.

Connection

Like all humans, however, being held in the consciousness of another, “beheld”, is when we become truly ourselves. When we haven’t been seen from infancy, we can often literally feel as if we might not exist or be “real”. This is an extremely painful form of neglect and developmental trauma.

It is crucial for us to establish baseline safety in relationship and within our self system as we can become unbalanced easily. This can need reinforced multiple times. Autistic people are also prone to turn on themselves and rejection sensitivity is very common.

Nervous system

Connection for Autistic people looks different than it might look for non autistic people. “Safe” ventral connection and communication in polyvagal theory, for example, needs expanded for Autistic people – our body language and eye contact are distinctive and we often do not communicate using neurotypical templates such as turn-taking. Many of us communicate via writing, texting, parallel play or creative means. We also very often have some of our most primary connections with pets, nature or a particular environment.

In effect, Autistic people have a different nervous system or “bodymind” than neurotypical people and therefore the messages being sent within this system need to be understood and attended to on their own terms.  The messages or signals telling us, for example, to move, breathe and respond will be different and distinctive from neurotypical people.  This affects our thoughts, feelings, memory, senses, sleep, digestion and all our bodily processes including healing and aging. We are constantly managing “too much” information coming in, though some of us will have developed strong numbing parts to manage this.

This means that when we come to explore neuroception in therapy we need to go slowly and carefully. Due to the high sensitivity of our nervous system coupled with the fact there are almost always high levels of trauma, we begin from a place of greater reactivity. In Polyvagal theory we might say that the vagal brake is often loose. This means that the pathway from calm to shutdown can be sudden and quick. Similarly, a small amount of activation can threaten overwhelm. Many of our parts live in sympathetic arousal a lot of the time and many others can be deep in dorsal disconnection.

Accessing parts

It is also important to be mindful of our interoception and the effects of bringing awareness to sensory aspects of our experience. Some of us are hypo or hyper sensitive and this can vary from one day to another. We also often experience high anxiety or a feeling of disorientation around “going inside” and / or closing our eyes. Stillness as a state can feel very threatening and, on the flip side, movement we don’t control can be deeply settling. We can have unusually high or unusually low pain thresholds too and - commonly due to adverse experiences within healthcare - we can be confused and hesitant around communicating how we experience this in our bodies.

Aphantasia is very common for Autistic people and this means that many therapeutic modalities need to be adapted in order to be effective. For example, with IFS if we cannot “see” things inside our minds (nor sense them in our bodies) we need another way to relate to our parts. For some of us, externalisation is a useful way to do this – using 3D figures or mark-making on paper. For others, it may be helpful to work with colleagues who can represent / constellate parts.

A large majority of us experience alexithymia, meaning that we don’t feel things the way society seems to expect, and we can have delayed affect. It is therefore unhelpful to ask us directly how we feel and each person will have their own unique ways of coming to know themselves. It is very important to be aware that just because someone seems “ok” during or at the end of a session, we cannot assume this will remain so. Autistic people take in so much that there is usually a prolonged processing and consolidation period afterwards.

Integration

Because of the hyper connectivity within our brain structures, I find that the

therapeutic approaches which are most healing are those which are mindful of the pace of sessions and the need for consolidation. On a practical level this means that “less is more” during sessions, even though we can sometimes resist this at the time.

Our monotropism means we can hyper focus in session and this can also cause a struggle with time and boundaries. We need very sensitive support with this so that the transitions in and out of sessions are not alarming.

There is also a very real need for what can look like inertia but is actually a profound integration. It often precedes quite a significant shift towards greater wholeness and fulfillment. I find therefore that flexibility around breaks and frequency of sessions is very often required.

Finding ourselves

Burnout is extremely common – if an autistic person isn’t currently in burnout they will almost certainly have had experiences of it. Autistic burnout is a specific category which shouldn’t be conflated with other types of burnout. It is sometimes said that in workplace burnout the person has “lost themselves” / given themselves away. For the autistic person this can have been lifelong and indeed the process of becoming “un-lost” is actually a finding for the first time, an actualisation or “coming into being”.

Recovery from burnout takes an extremely long time and often involves extended time alone. Autistic people sometimes speak of a process of truly finding and embracing themselves as they are, being able to safely “unmask”.

On the subject of “masking”, it’s important to say that for an autistic person this has both conscious and unconscious elements and covers the majority of, if not all, areas of life. It needs to be addressed sensitively as there is a lot of shame associated with being “found out”. It can be more accurate sometimes to speak about “adapting” rather than “masking” if this brings up negative associations of pretending. “False self” and “persona” are also usually confusing and unhelpful concepts to us.

The most useful explanation which has resonated for me is to see masking as an unconscious trauma response. It will therefore only change organically if the relationship and environment feel safe on a cellular level. I cannot consciously choose to “unmask” as masking bypasses the cognitive level and is a much more primitive response.

Empathy

Autistic experiences of empathy and how we communicate this - and benefit from it when offered by others - is different to our non autistic peers. For example, because we are so accustomed to not naturally understanding others (from our own point of view) we work really hard to do so. However, in order to do this, we sometimes suspend our own reality for the time. This is rightly called empathy in that we sense into and experience what it is like to “be” the other person in those moments and we reflect deeply on it afterwards. The risk of this can be that we lose track of ourselves within the relationship.

Empathy between autistic people, on the other hand, can look very different to this. For many of us, one of the most healing things we can say to each other is “Me too”. This is contrary to (neurotypical) therapy training. One reason why it can be so powerful is due to the profound feelings of isolation and lack of mirroring or representation most Autistic people have experienced.

It is worth mentioning here the harm caused by the "Theory of Mind" hypothesis which has persisted within the field since the 1990s. This theory suggests that Autistic people struggle with understanding that others have thoughts, feelings, and perspectives different from their own (mindblindness).

In fact, however, this theory oversimplifies the complex communication differences between Autistic and non-Autistic (allistic) people in placing the pressure on Autistic people to conform to neuronormative ways communicating rather than looking at both on their own terms. In 2012 Dr. Damian Milton described this as the "double empathy" problem, a kind of cultural gap between autistic and non autistic people. Dr. Catherine Crompton's research has further demonstrated these dynamics, showing that connection / rapport between autistic people was similar to their neurotypical counterparts. The greatest difficulties were within mixed neurotype pairs and groups.

To be continued

I've been waiting to publish this for a few weeks in the hope that somehow I would find a neat way to summarise and conclude. That hasn't happened, however, so I am choosing to let it sit as it is. I hope there are aspects of it which prove helpful to you and I am very open to feedback and discussion - therapywithsiana@gmail.com.

Copyright: Siana McGarvey, March 2025